Affective disturbances modulate the neural processing of visceral pain stimuli in irritable bowel syndrome: An fMRI study

Institute of Medical Psychology and Behavioral Immunobiology, University Clinic of Essen, University of Duisburg-Essen, Germany.
Gut (Impact Factor: 14.66). 09/2009; 59(4):489-95. DOI: 10.1136/gut.2008.175000
Source: PubMed


To address the role of anxiety and depression symptoms in altered pain processing in irritable bowel syndrome (IBS).
In this functional magnetic resonance imaging study, the blood oxygen level-dependent (BOLD) response to rectal distensions delivered at previously determined individual discomfort thresholds was assessed.
15 female patients with irritable bowel syndrome (IBS) and with normal rectal pain thresholds, and 12 healthy women.
The correlation of anxiety and depression symptoms, measured with the Hospital Anxiety and Depression Scale (HADS), with subjective pain ratings and the BOLD response during distension-induced brain activation were analysed within IBS. Group differences in pain-induced brain activation with and without controlling for HADS scores were evaluated.
Patients with IBS experienced significantly more pain and discomfort upon rectal distensions in the scanner, despite unaltered rectal sensory thresholds. Anxiety and depression scores were associated with these subjective stimulus ratings, but not with rectal sensory thresholds. Anxiety symptoms in IBS were significantly associated with pain-induced activation of the anterior midcingulate cortex and pregenual anterior cingulate cortex. Depression scores correlated with activation of the prefrontal cortex (PFC) and cerebellar areas within IBS. Group comparisons with the two-sample t test revealed significant activation in the IBS versus controls contrast in the anterior insular cortex and PFC. Inclusion of anxiety and depression scores, respectively, as confounding variables led to a loss of significant group differences.
Altered central processing of visceral stimuli in IBS is at least in part mediated by symptoms of anxiety and depression, which may modulate the affective-motivational aspects of the pain response.

Download full-text


Available from: Christina Rosenberger,
  • Source
    • "The individual brain activity during anticipation of a rectal distension has been shown to be potentially influenced by the subject's psychological and affective state (Elsenbruch et al., 2010; Guthrie et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The human brain responds both before and during the application of aversive stimuli. Anticipation allows the organism to prepare its nociceptive system to respond adequately to the subsequent stimulus. The context in which an uncomfortable stimulus is experienced may also influence neural processing. Uncertainty of occurrence, timing and intensity of an aversive event may lead to increased anticipatory anxiety, fear, physiological arousal and sensory perception. We aimed to identify, in healthy volunteers, the effects of uncertainty in the anticipation of uncomfortable rectal distension, and the impact of the autonomic nervous system (ANS) activity and anxiety-related psychological variables on neural mechanisms of anticipation of rectal distension using fMRI. Barostat-controlled uncomfortable rectal distensions were preceded by cued uncertain or certain anticipation in 15 healthy volunteers in a fMRI protocol at 3T. Electrocardiographic data were concurrently registered by MR scanner. The low frequency (LF)-component of the heart rate variability (HRV) time-series was extracted and inserted as a regressor in the fMRI model ('LF-HRV model'). The impact of ANS activity was analyzed by comparing the fMRI signal in the 'standard model' and in the 'LF-HRV model' across the different anticipation and distension conditions. The scores of the psychological questionnaires and the rating of perceived anticipatory anxiety were included as covariates in the fMRI data analysis. Our experiments led to the following key findings: 1) the subgenual anterior cingulate cortex (sgACC) is the only activation site that relates to uncertainty in healthy volunteers and is directly correlated to individual questionnaire score for pain-related anxiety; 2) uncertain anticipation of rectal distension involved several relevant brain regions, namely activation of sgACC and medial prefrontal cortex and deactivation of amygdala, insula, thalamus, secondary somatosensory cortex, supplementary motor area and cerebellum; 3) most of the brain activity during anticipation, but not distension, is associated with activity of the central autonomic network. This approach could be applied to study the ANS impact on brain activity in various pathological conditions, namely in patients with chronic digestive conditions characterized by visceral discomfort and ANS imbalance such as irritable bowel syndrome or inflammatory bowel diseases. Copyright © 2014 Elsevier Inc. All rights reserved.
    NeuroImage 12/2014; 107. DOI:10.1016/j.neuroimage.2014.11.043 · 6.36 Impact Factor
  • Source
    • "Studies have continued to demonstrate the distinct advantages of moxibustion and provide some reliable evidence for explaining the mechanism of moxibustion treatment of IBS. The application of neurophysiological and functional brain imaging techniques in IBS studies helps to reveal the mechanism underlying the treatment effect of moxibustion on IBS patients with visceral pain at the level of the central nervous system, especially in studies on the mechanisms of IBS associated with emotional factors [47], and promotes in-depth clinical investigations on the pathological mechanisms of human IBS. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Irritable bowel syndrome (IBS) is a functional bowel disorder that causes recurrent abdominal (visceral) pain. Epidemiological data show that the incidence rate of IBS is as high as 25%. Most of the medications may lead to tolerance, addiction and toxic side effects. Moxibustion is an important component of traditional Chinese medicine and has been used to treat IBS-like abdominal pain for several thousand years in China. As a mild treatment, moxibustion has been widely applied in clinical treatment of visceral pain in IBS. In recent years, it has played an irreplaceable role in alternative medicine. Extensive clinical studies have demonstrated that moxibustion for treatment of visceral pain is simple, convenient, and inexpensive, and it is being accepted by an increasing number of patients. There have not been many studies investigating the analgesic mechanisms of moxibustion. Studies exploring the analgesic mechanisms have mainly focused on visceral hypersensitivity, brain-gut axis neuroendocrine system, and immune system. This paper reviews the latest developments in moxibustion use for treatment of visceral pain in IBS from these perspectives. It also evaluates potential problems in relevant studies on the mechanisms of moxibustion therapy to promote the application of moxibustion in the treatment of IBS.
    Evidence-based Complementary and Alternative Medicine 07/2014; 2014(2014). DOI:10.1155/2014/895914 · 1.88 Impact Factor
  • Source
    • "A recent meta-analysis of the studies investigating differences in the brain response to rectal distension between individuals with IBS and controls found differences in activation of the amygdala, thalamus, prefrontal, anterior cingulate, and insular cortices (Tillisch et al., 2011), all of which play an important role in pain processing (Tracey and Mantyh, 2007). When studies are limited to those only including female subjects, the findings are regionally similar, with rectal distension eliciting decreased activation in the amygdala and hippocampus (Wilder-Smith et al., 2004) and increased activation in the insular and prefrontal cortices (Elsenbruch et al., 2010) in women with IBS compared with healthy women. However, in the latter study, significance was lost when anxiety and depression measures were included. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Chronic pelvic pain (CPP) is a significant public health problem with 1 million affected women in the UK. Although many pathologies are associated with CPP, the pain experienced is often disproportionate to the extent of disease identified and frequently no pathology is found (chronic pelvic pain syndrome). The central nervous system (CNS) is central to the experience of pain and chronic pain conditions in general are associated with alterations in both the structure and function of the CNS. This review describes the available evidence for central changes in association with conditions presenting with CPP.
    Human Reproduction Update 06/2014; 20(5). DOI:10.1093/humupd/dmu025 · 10.17 Impact Factor
Show more